Addressing the plight of underappreciated frontline health workers

Chrisha Ane Magtubo, Elma Sandoval, 30 May 2017

Many BHWs have grown old serving their communities Photo courtesy of the provincial government of Quezon

It was in the 1970s when the first barangay (village) health workers started to volunteer their services to communities, attached to public health stations. In the early days, one BHW was assigned to 20 families in their community.

Community health centers are composed of a nurse, midwife and barangay health workers (BHW). But unlike the nurse and midwife who are salaried employees of the local government, BHWs are classified as volunteers.

Hard work, too little pay

For almost two decades, BHWs, many of whom were full-time volunteers, rendered service without any form of compensation. It was only in the mid-1990s when a law was enacted mandating benefits and incentives for these volunteer workers.

Still, they remained volunteers and had no security of tenure in spite their dedication and commitment. BHW often go above and beyond their duties, and a meager allowance notwithstanding, are known to shell out cash to help indigent residents so they can come to the health centers and be seen to by a healthcare worker or buy medication they badly need.

Health volunteers play a huge role in maternal, infant, and child health care at the community level. It is not uncommon for BHWs to go house-to-house to ensure pregnant women come in for regular prenatal check-ups or to remind mothers to bring in their kids for vaccination.

They assist midwives and nurses for wellness, treatment and emergency cases. Because they are members of the community themselves, BHWs are trusted by families, making their participation in healthcare delivery invaluable.

Factors behind inequity

Educating families on family planning, vaccination, sanitation and hygiene, as well as familiarizing people about infectious diseases and their prevention are also included in the BHWs’ duties.

Considering their contribution to health care delivery, BHWs should be properly rewarded for their service. Unfortunately, this is not the case.

While they are entitled to a subsistence allowance and hazard pay under the Barangay Health Workers Benefits and Incentives Act of 1995, the amounts are not equal for every BHW. Instead, they are dependent on how much local government units - where they are directly under - will allocate for them. The amounts range from as low as Php500 to a high of Php6,000, still far lower than the mandated minimum wage.

To address this injustice, lawmakers have been proposing measures but have yet to be successful.

The most recent proposal was House Bill No 125, or an Act Authorizing the Grant of Compensation in the Form of Additional Honorarium to Barangay Health Workers, has been endorsed for plenary debates.

Additional incentives

Under the bill, BHWs would be granted an honorarium of Php 4,000 on top of the incentives and allowances they are currently entitled to.

According to its author, South Cotabato Rep. Pedro Acharon Jr, the bill will secure the welfare of the BHWs and of the state in general.

However, for the measure to be signed into law, a counterpart bill must be approved by the Senate. Congress, however, is due to adjourn its first regular session on the first week of June.

Based on the data from the Department of Health, there are presently 196,562 active and accredited BHWs as of 2009. According to DOH guidelines, a barangay health worker is one who has undergone a training programme, given by an accredited government or non-government organization to qualify.

Congressman Acharon’s proposed measure also included a provision authorizing the national government to subsidize fourth, fifth, and sixth municipality classes to pay the BHWs honorariums. These are local government units whose incomes are smaller and not sufficient provide an additional honorarium for the volunteers.

A typical scene in barangay health stations Photo courtesy of the City of Valenzuela

Taking action

Meanwhile, in the absence of a law, DOH-MIMAROPA regional office has vowed to fill in this gap for the 13,000 BHWs in the region. MIMAROPA is composed of the provinces of Oriental and Occidental Mindoro, Marinduque, Romblon, and Palawan.

Regional Director Eduardo Janairo recently made the announcement during a gathering of 200 municipal presidents of BHW organizations in the region.

“It is about time to give our BHWs what is due them: their benefits, incentives and more support from the government,” Director Janairo said. “Being the real national heroes who voluntarily dedicate their life in the pursuit of providing primary health care in their community without expecting anything in return.”

Operational support

The additional incentives include Php 500,000 for each BHW federation as operational funds for two to three years that can be used for travel expenses, support for patient’s expenses, workshops and training, and an additional funding of Php 100,000 for a planned convention.

The regional chief likewise announced that BHWs will be enrolled under Philhealth’s Point of Care programme and the Philippine Charity Sweepstakes Office to make them eligible for medical and hospitalization benefits.

Further, the regional office will implement a one-child full scholarship policy for all children of BHWs who want to pursue a college degree.

The volunteer health workers will now be equipped their own health apparatus like a stethoscope and blood pressure measuring device. They will also undergo basic computer literacy training.

While the incentives are already stipulated under the BHW law, they are hardly implemented equally. After five years of service, BHWs are supposedly civil service eligible and can avail of free legal services.

To further augment the income of BHWs, they have been encouraged to draw up income-generating proposals for their respective provinces, and approved proposals will be funded by the regional health office for up to Php 1 million.

Director Janairo vowed to support BHWs in the region until they become qualified and are self-sufficient, as he encouraged them to give importance to every provision and assistance afforded to them by the office because “these provisions will not be enduring.” MIMS

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